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External Quality Review

NMMRA has provided independent external quality review and EQR-related services since 2005. NMMRA provides study, design, data collection, data analysis, and reporting required as part of its EQR contracts. Our EQR team members are highly experienced and committed to quality improvement. NMMRA experts have designed, developed, and implemented quality improvement programs in state Medicaid agencies and managed care organizations (MCOs).

Staff Expertise

  • Medicaid programs and population characteristics, policies, data systems, and processes
  • Managed care delivery systems, organizations, and financing; including a single, statewide behavioral health entity
  • Quality assessment and improvement methods
  • Research design and methodology, including statistical analysis
  • Presentations to providers and professional groups

 
Services

  • Validating or conducting performance measures
  • Validating or conducting performance improvement projects
  • Conducting contractual compliance and regulatory reviews for MCOs and prepaid inpatient health plans (PIHPs)
  • Performing encounter data validation
  • Validating or administering consumer or provider surveys
  • Performing readiness reviews for MCOs/PIHPs
  • Evaluating, designing, and conducting focused quality of care studies
  • Conducting individual case review
  • Performing information system audits for states and MCOs/PIHPs
  • Providing technical assistance to MCOs/PIHPs
  • Evaluating federally mandated Medicaid Quality Assessment and Performance Improvement Strategy
  • Designing and conducting utilization review audits
  • Providing formalized training to state agencies and MCOs/PIHPs

 
Resources

  • NM QIO News
  • Top Places
  • QEC